- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... guidelines to determine the appropriate level of care and the medical necessity of continued hospitalization. Secures initial payer authorization and continued… more
- Centene Corporation (New York, NY)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance… more
- Essentia Health (Detroit Lakes, MN)
- **Job Description:** Seeking a Registered Nurse to serve at Essentia Health in home health for the Detroit Lakes, Minnesota area. This RN supports quality review ... facility. Must reside within driving distance of St. Mary's Medical Center in Detroit Lakes. No weekend, holiday, or...emergency conditions. Specific duties in this position include quality review for Oasis and review of plans… more
- AmeriHealth Caritas (LA)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical ... Degree in Nursing (BSN) preferred. + An active Registered Nurse (RN) license in good standing is required. +...and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care… more
- AmeriHealth Caritas (Washington, DC)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical ... document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, and… more
- UNC Health Care (Kinston, NC)
- …the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care, ... movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as… more
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... appeals requests using Medicare criteria. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by… more
- Ascension Health (Wichita, KS)
- **Details** + **Department:** Utilization Review + **Schedule:** Full time, 36 hrs, Day shift, 7:30 AM- 4:00 PM, Monday-Friday, rotating weekends possible + ... health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... on performance improvement of the UR KPI's. Ensures proper and accurate medical record documentation. **Essential Functions** + Reviews new admissions using 3rd… more
- BJC HealthCare (St. Louis, MO)
- … experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity + Must ... million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional… more